The long term objective of this project is to plan an effective state-wide Pregnancy Associated Mortality Review (PAMR) system in Ohio. Pregnancy associated deaths include all deaths to women either during pregnancy or with in one year of the end of a pregnancy, regardless of the cause. In addition, for every pregnancy associated death, it is estimated that there are another fifty women who experience severe morbidity as a result of complications of pregnancy, labor or delivery. In Ohio, there are approximately 40 maternal deaths annually so this would extrapolate to another 2,000 women who experience significant morbidity. Maternal death reviews benefit both groups of women. Pregnancy-associated mortality review (PAMR) is a perfect example of a process where a focus on patient safety and prevention of adverse events would lead to improvements in both healthcare system operations and clinical care. This would, in turn, decrease the potential for medical liability claims. According to a recent report by the Ohio Department of Insurance, in 2006 there were 4,004 total medical malpractice claims filed with twenty percent resulting in indemnity claims. Obstetric-related claims were the category with the highest average in paid indemnity claims ($726,506). Florida's PAMR process has identified clinical factors as an area for improvement in 71% of cases reviewed and system factors in 12% of such cases. Ohio has never engaged in a state- wide process for PAMR but the Department of Health has experience with other quality improvement programs. There has been a state-wide child fatality review program in place for over ten years and in 2007, the ODH partnered in the development of the Ohio Perinatal Care Collaborative, an initiative to improve birth outcomes. This current application describes a planning effort between the Ohio State University Colleges of Medicine and Public Health with the Ohio Department of Health to develop a state-wide PAMR process for Ohio. The investigators and key personnel have the skill set necessary to be successful in this endeavor to improve patient safety and decrease medical liability. PUBLIC HEALTH RELEVANCE: Women in the United States still die from complications related to pregnancy and delivery. Most are because of failures in protecting patient safety. A systematic approach to improving safety will not only decrease the risk of mortality associated with pregnancy but decrease the potential for medical liability claims.